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Labor Day Holiday Día del Trabajo

Texas Children's Health Plan will be closed on Monday, September 1st, in observance of Labor Day. In our absence, you can reach our after-hours nurse help line at 1-800-686-3831. We will resume normal business hours on Tuesday, September 2nd. Wishing you a safe and happy Labor Day!

Texas Children's Health Plan estará cerrado el lunes 1 de septiembre por el Día del Trabajo. Durante nuestra ausencia, puedes comunicarse con nuestra línea telefónica de ayuda fuera del horario habitual al 1-800-686-3831. Reanudaremos nuestro horario regular el martes 2 de septiembre. ¡Te deseamos un feliz y seguro Día del Trabajo!

New Rewards Coming Soon! ¡Se vienen nuevas recompensas!

Our Healthy Rewards Program is getting an update in September! For a sneak peek of all the changes - including new rewards and ways to redeem them - please click here.

¡Nuestro Programa Healthy Rewards tendrá su actualización en septiembre! Para ver un adelanto de todos los cambios, incluyendo nuevas recompensas y formas de canjearlas, haz clic aquí.

COVID-19 Medicaid Pharmacy Benefit Updated May 4, 2020

Attention: All Providers and PharmaciesEffective Date: May 4, 2020 The Texas Vendor Drug Program (VDP) has implemented several changes in response to COVID-19. This notice contains the latest updates, as well as links to the previously implemented changes. No-auto prior authorization (NAP) designation temporarily lifted: Normally, medications listed as NAP on the drug formulary by VDP require a manual hard stop in the system. Providers must call/fax to complete a prior authorization (PA) rather than allowing automated authorizations by reviewing historical pharmacy and medical claims. In response to COVID-19, VDP changed NAP designations to NDP to reduce administrative burden. This may allow MCOs to determine if non-preferred criteria is met automatically with review of pharmacy and medical claims data. Please note that all NPA designations cannot be automated right away, and some will still require manual fax or call-in from the prescriber. Azithromycin shortage: There have been reported shortages of azithromycin. VDP is unable to add other NDCs or antibiotic medications to the formulary. In the event pharmacies are unable to dispense the drug, providers, pharmacies, and MCOs should coordinate care to identify alternatives listed on the Medicaid formulary based on patient factors and diagnosis. Below are the actions VDP has taken previously in response to VDP. Temporary expansion of NDCs Temporary expansion of drug list within classes How this impacts providers: Pharmacies may not have access to certain medications due to shortages, and patients may need alternative therapies. Next steps for providers: Providers, pharmacies, and MCOs should coordinate care to identify alternatives listed on the formulary based on patient factors and diagnosis. In the event no other antibiotic on the formulary is appropriate, and a non-formulary drug is medically necessary, providers and pharmacies should notify the MCO, who will submit a request to VDP for an overrideIf you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.For access to all provider alerts,log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers